Over 4.4 million stroke survivors in the United States are at risk of a recurrent stroke, making this an important public health issue in the US. Given the impact of stroke, a key goal of the nation's health objectives, Healthy People 2010, is to reduce the burden of stroke and its outcomes especially among priority populations such as the elderly, ethnic minorities and women. Attainment of this goal requires a detailed understanding of stroke and its outcomes across the country so that prevention efforts can be efficiently and effectively implemented. Geographic and racial patterns in stroke incidence and mortality have been identified; however, there is currently little information about patterns of stroke recurrence. The objective of this study is to examine the geographic patterns in the risk of recurrent stroke by gender and race and to determine whether differences in risk factors prevalence and healthcare resources and utilization explain these differences. To do this we will use longitudinally linked Medicare data from 1993-2002 to determine the rate of recurrent ischemic stroke within 1-year of an incident stroke. We will use geographic information systems (GIS) to map the 1-year recurrent stroke rates for each county by gender and race across the United States. Analyses will include hierarchical modeling to adjust for individual risk factors including patient characteristics such as age, comorbid and chronic diseases. In addition, we will use hierarchical modeling to adjust for both individual risk factors as well as county level risk factors from the Behavioral Risk Factor Surveillance Study (BRFSS) and data collected from the Area Resource File (ARF), in order to study whether variations in risk factor prevalence and health care resources/utilization influence recurrent stroke rates. This study proposal will provide health care providers, patients, administrators, consumers, and policymakers with insight into specific populations at the greatest risk of recurrent stroke. This information is of vital importance in improving the efficiency of the health [unreadable] care system in delivering secondary stroke prevention and targeting effective prevention efforts to those [unreadable] individuals in the greatest need. [unreadable] [unreadable] [unreadable]